ATI RN
Fluid and Electrolytes ATI Questions
Question 1 of 5
A 73-year-old man who slipped on a small carpet in his home and fell on his hip is alert and oriented; PERRLA (pupils equally round and reactive to light and accommodation) is intact, and he has come by ambulance to the emergency department (ED). Heart rate elevated, he is anxious and thirsty. A Foley catheter is in place and 40mL of urine is present. The nurse's most likely explanation for the urine output is:
Correct Answer: D
Rationale: Renin is released by the juxtaglomerular cells of the kidneys in response to decreased renal perfusion. Angiotensin-converting enzyme converts angiotensin I to angiotensin II. Angiotensin II, with its vasoconstrictor properties, increases arterial perfusion pressure and stimulates thirst. As the sympathetic nervous system is stimulated, aldosterone is released in response to an increased release of renin, which decreases urine production. Based on the nursing assessment and mechanism of injury, this is the most likely cause of the lower urine output.
Question 2 of 5
A nurse in the medical-surgical unit has a newly admitted patient who is oliguric; the acute care nurse practitioner orders a fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes. The nurse is aware this intervention will help:
Correct Answer: C
Rationale: If a patient is not excreting enough urine, the health care provider needs to determine whether the depressed renal function is the result of reduced renal blood flow, which is a fluid Volume deficit (FVD) or prerenal azotemia, or acute tubular necrosis that results in necrosis or cellular death from prolonged FVD. A typical example of a fluid challenge involves administering 100 to 200 mL of normal saline solution over 15 minutes. The response by a patient with FVD but normal renal function is increased urine output and increased blood pressure.
Question 3 of 5
A nurse is taking care of a 65-year-old female patient in a medical-surgical unit who is in renal failure; during the assessment the patient complains of tingling in her lips and fingers. When the nurse takes her blood pressure, she has a spasm in her wrist and hand. The nurse suspects:
Correct Answer: B
Rationale: Tetany is the most characteristic manifestation of hypocalcemia and hypomagnesemia. Sensations of tingling may occur in the tips of the fingers, around the mouth, and less commonly in the feet. Taking a normal blood pressure could illicit a carpal spasm if it creates slight ischemia of the ulnar nerve.
Question 4 of 5
A patient who is in renal failure partially loses the ability to regulate changes in pH because the kidneys:
Correct Answer: C
Rationale: In renal failure, the kidneys are unable to effectively excrete metabolic acids, leading to acid-base imbalances. The correct answer is C) Regenerate and reabsorb bicarbonate to maintain a stable pH. Bicarbonate is a key buffer in the body that helps regulate pH by neutralizing excess acids. In renal failure, impaired kidney function results in decreased bicarbonate reabsorption, leading to metabolic acidosis. Option A is incorrect because the kidneys do not regulate carbonic acid to change pH; rather, they regulate bicarbonate levels. Option B is incorrect as the primary role of the kidneys in acid-base balance is through bicarbonate regulation, not electrolyte changes. Option D is incorrect as carbonic acid and bicarbonate are part of the bicarbonate buffering system, not directly combined by the kidneys to regulate pH. Understanding the role of the kidneys in acid-base balance is crucial for nurses caring for patients, especially those with renal failure. By grasping how impaired kidney function affects pH regulation, nurses can anticipate and manage acid-base imbalances effectively to provide optimal patient care.
Question 5 of 5
A 65-year-old male patient was admitted to a medical-surgical unit 72 hours ago with pyloric stenosis; a nasogastric tube was inserted upon admission and has been on low intermittent suction since then. The nurse taking care of the patient notices that his potassium is very low and becomes concerned that the patient may be at risk for:
Correct Answer: C
Rationale: Probably the most common cause of metabolic alkalosis is vomiting or gastric suction with loss of hydrogen and chloride ions. The disorder also occurs in pyloric stenosis in which only gastric fluid is lost. Vomiting, gastric suction, and pyloric stenosis all remove potassium and can cause hypokalemia.